Imagery-Focused Therapy for Visual Hallucinations: A Case Series

Georgie Paulik, Christopher Taylor

Research output: Contribution to journalArticlepeer-review


Introduction: Visual hallucinations (VH) are more common than previously thought and are linked to higher levels of distress
and disability in people with a psychotic illness. Despite this, scant attention has been given to VHs in the clinical literature, and
the few therapy case series of cognitive behavioural therapy (CBT) published to date have not demonstrated reliable change. In
other areas of clinical research, problematic mental imagery has been found to be more strongly related to negative affect in psychological disorders than negative linguistic thinking, and imagery focused techniques have commonly been found to improve
the outcomes in CBT trials. Given VHs have many similarities with visual mental imagery and many of the distressing beliefs
associated with VHs targeted in CBT are maintained by accompanying mental imagery (i.e., imaging a hallucinated figure attacking them), it seems plausible that an imagery-focused approach to treating VHs may be most effective.
Methods: The current study is a multiple baseline case series (N=11) of a 10-session imagery-focused therapy for VH in a transdiagnostic sample.
Results: The study had good attendance and feedback, no adverse events and only one [seemly unrelated] drop-out, suggesting
good feasibility, safety and acceptability. The majority of clients reported reduction on both full-scale measures (administered
at 3 baselines, mid-therapy, posttherapy and 3-month follow-up) and weekly measures of VH severity and distress, ranging from
medium to large effect sizes.
Conclusions: The case series suggests that an imagery-focused approach to treating VHs may be beneficial, with a recommendation for more rigorous clinical trials to follow
Original languageEnglish
Pages (from-to)1-16
Number of pages16
JournalClinical Psychology & Psychotherapy
Publication statusPublished - 10 May 2024


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